Ministry of Health and Welfare to Publicize List of Medical Institutions Sanctioned for False Insurance Claims
The Ministry of Health and Welfare, led by Minister Jeong Eun-kyung, will begin publishing a list of 26 medical institutions penalized for falsely claiming health insurance nursing care benefits. The list will be available on the Ministry’s website,as well as those of related organizations,starting November 27th. This announcement occurs twice annually, covering penalties assessed in the first and second halves of the year.
The sanctioned institutions include a breakdown of facility types: one hospital,sixteen clinics,two dental clinics,one oriental medicine hospital,and six oriental medicine clinics. These penalties – suspensions and fines – were levied following a review by the Health Insurance Announcement Deliberation committee for claims made between July 2024 and the end of February 2025.
Among the cases, one medical institution (referred to as “Medical Institution A”) was found to have fraudulently billed 30.43 million won by falsely recording patient visits and charging for services not rendered, including medication (Denogan) that was never administered. The Ministry responded with a 93-day business suspension, recovery of the ill-gotten gains, public listing of the violation, and a referral for criminal examination.
Another institution (“Medical Institution B”) improperly billed 29.4 million won by charging patients for non-covered treatments and than submitting those same treatments as covered medical benefits. This resulted in a 45-day business suspension, recovery of profits, public listing, and criminal charges.
The publication of these lists is mandated by Article 100 of the National Health Insurance Act and applies to institutions meeting either of the following criteria: a false claim amount of 15 million won or more, or a false claim ratio exceeding 20% of total nursing care benefit costs.
the Health Insurance Announcement Deliberation committee, comprised of eleven members representing consumer groups, journalism, legal expertise, and the pharmaceutical industry, determines which cases warrant public announcement. Affected institutions are given a 20-day period to respond before the list is finalized.
The published data will include the institution’s name, address, type, representative’s name, license number, specific violation, and the administrative action taken. This information will be available on the websites of the Ministry of Health and welfare, the Health Insurance Review & Assessment Service (HIRA), the National Health Insurance Service (NHIS), local governments, and public health centers for six months, from November 27, 2025, to May 26, 2026.
Lee Jung-gyu, Director of the Health Insurance Policy Bureau, stated the Ministry will continue to strengthen investigations into suspected fraudulent claims and utilize public announcements to deter future financial losses within the health insurance system.
